Healthcare Provider Details

I. General information

NPI: 1528516853
Provider Name (Legal Business Name): MEHMET CEM MOCAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W TAYLOR ST SUITE 2142
CHICAGO IL
60612-7242
US

IV. Provider business mailing address

1855 W TAYLOR ST SUITE 2142
CHICAGO IL
60612-7242
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-6599
  • Fax: 312-996-7770
Mailing address:
  • Phone: 312-996-6599
  • Fax: 312-996-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number113000078
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: